OSCE Omg

Question 1

In a CN IX Palsy which way will the uvula deviate?

Answer 1

Glossopharyngeal.

Uvula deviates AWAY from the side of the nerve palsy

Question 2

In a CN XII Palsy which way will the tongue deviate

Answer 2

Hypoglossal.

Tongue deviates TOWARDS the side of the nerve palsy

Question 3

Which nerve roots coordinate shoulder abduction?

Answer 3

C5

Question 4

Which nerve roots coordinate shoulder adduction?

Answer 4

C6/7

Question 5

Which nerve roots coordinate elbow flexion?

Answer 5

C5/6

Question 6

Which nerve roots coordinate elbow extension?

Answer 6

C7

Question 7

Which nerve roots coordinate wrist extension?

Answer 7

C6

Question 8

Which nerve roots coordinate wrist flexion?

Answer 8

C6/7

Question 9

Which nerve roots coordinate finger extension?

Answer 9

C7

Question 10

Which nerve roots coordinate finger abduction

Answer 10

T1

Question 11

Which nerve roots coordinate thumb abduction?

Answer 11

C8/T1

Question 12

Which nerve roots coordinate hip flexion?

Answer 12

L1/2

Question 13

Which nerve roots coordinate hip extension?

Answer 13

L5/S1

Question 14

Which nerve roots coordinate hip abduction?

Answer 14

L2/3

Question 15

Which nerve roots coordinate hip adduction

Answer 15

L4/5

Question 16

Which nerve roots coordinate knee flexion?

Answer 16

S1

Question 17

Which nerve roots coordinate knee extension?

Answer 17

L3/4

Question 18

Which nerve roots coordinate ankle dorsiflexion?

Answer 18

L4

Question 19

Which nerve roots coordinate ankle plantarflexion?

Answer 19

S1/2

Question 20

Which nerve roots coordinate toe flexion?

Answer 20

L5

Question 21

Which nerve roots coordinate ankle inversion?

Answer 21

L4

Question 22

Which nerve roots coordinate ankle eversion?

Answer 22

L5/S1

Question 23

What are the componenets you should ask about when using Diabetes Risk score?

Answer 23

Age, ethnic background, 1st degree relative with DM, hypertension, sex, waist circumference, BMI, common symptoms (polyuria, polydypsia, unexplained weight loss, visual blurring, infection and fatigue)

Question 24

What are the componenets you ask about when using QRISK2 score?

Answer 24

Age, Sex, Smoking status, Diabetes status, Antihypertensives use, AF, RA, CKD stage 4/5, Angina/MI in 1st degree relative.
Also = BMI, Systolic BP, Postcode, Ethnicity and Cholesterol/HDL level

Question 25

What are the componenets you ask about when using CHA2DS2-VASc score?

Answer 25

``` Congestive Heart Failure Hypertension Age (65-74 = 1 point, >75 = 2 points) Diabetes Sex (female = 1 point) Stroke history Peripheral vascular disease ```

Question 26

What is normal INR on warfarin?

Answer 26

2-3

Question 27

What are the componenets you ask about when using Well's score?

Answer 27

Bedridden? Recent major surgeries? Paralysis/immobilisation? History of DVT? Active cancer? Recent flights? COCP/HRT? Smoking? Examine: pitting oedema, calf swelling >3cm, tenderness, collateral veins, whole leg swelling

Question 28

What are the componenets you ask about when using FRAX score?

Answer 28

Previous fracture, parental hip fracture, current smoking/alcohol intake, BMI, glucocoricoid use, RA, secondary oesteoporosis, age, sex, weight, height, femoral neck bone mineral density (DEXA scan)

Question 29

Which medical conditions can cause secondary osteoporosis?

Answer 29

Kidney failure, Cushing's, Coeliac, MS, Hyperparathyroidism, Hyperthyroidism, Diabetes

Question 30

What do the T-score results mean?

Answer 30

>= -1 = normal bone density -1 to -2.5 = oesteopenia <= -2.5 = oesteoporosis

Question 31

What should you say if you think a patient is high risk based on their QRISK 2 score?

Answer 31

Lifestyle advice! Healthy diet, weight loss, exercise, smoking cessation, disease control - adherance to medicaiton (if not already on medications consider starting)

Question 32

What should you say if you think a patient is at high risk or low risk based on their CHA2DS2VASc score?

Answer 32

High risk = anticoagulation/antiplatelet therapy Low risk = consider anticoaguant therapy (consider risks vs benefits) Lifestyle advice - healthy diet, exercise, smoking cessation and vitamin K in leafy green veg if on warfarin

Question 33

What should you say if you think a patient is risk based on their Well's score?

Answer 33

Investigations = D-dimer and USS doppler Treatment = LMW heparin, anticoagulants Lifestyle adivce = diet, exercise, smoking cessation, other RFs e.g. COCP

Question 34

What should you say if you think a patient is high risk based on their Diabetes Risk score?

Answer 34

Diet advice = regular meals, reduce portion sizes and starchy carbs, decrease fat, eat 5 fruits/veg, 2 portions of oily fish, limit sugar, decrease salt and moderate alcohol Exercise = 150 mins/week, increase HR and RR, build up gradually, walking/gardening/housework/cycling. If high risk can have tests! Benefits and effort from change > long term effects of diabetes

Question 35

What is the CHA2DS2VASc score?

Answer 35

Calculates the risk of stroke in patients with AF

Question 36

What is the QRISK 2 score?

Answer 36

Calculates the risk of CVD in the next 10 years

Question 37

What is HbA1c in diabetes and prediabetes?

Answer 37

``` Pre-diabetes = 42-48 Diabetes = >48 ```